Sampling variability and concordance between sequential and simultaneous adrenal venous sampling in primary aldosteronism subtype diagnosis
Authors' conclusion
Sequential AVS may be subject to bias due to stress-related cortisol changes over time, whereas simultaneous AVS provides better diagnostic concordance.
Study context
- Population
- Consecutive primary aldosteronism (PA) patients undergoing bilateral simultaneous unstimulated adrenal venous sampling (AVS), December 2024–January 2026final analysis
- Participants
- 55 patients
- Comparison
- Simultaneous vs simulated sequential AVS
- Outcome
- Diagnostic concordance (ICC and Kappa) for LI between sampling approaches
Methodological detailsconsecutive enrolment, simulated sequential AVS
- Consecutive enrolment
- Simulated sequential AVS
Performance
As reported in the abstract
Simultaneous AVS at different time points, intraclass correlation coefficient (ICC)
0.840
95% CI 0.764–0.895
Simultaneous vs simulated sequential, t5 vs t0-t5, ICC
0.680
95% CI 0.593–0.756
Simultaneous vs simulated sequential, t15 vs t0-t15, ICC
0.707
95% CI 0.560–0.820
Simultaneous AVS at 5-min interval: agreement 85.5%, Kappa
0.768
Further findings
| Outcome | P value |
|---|---|
| Cortisol over timet0 vs t5 | P < 0.05 for t0 vs. t5 |
Cortisol over time
- Significant gradual decline in cortisol over time; substantial temporal variability in lateralization index (LI)
LI bias with sequential AVS
- Systematic LI differences: underestimation in right-dominant unilateral PA, overestimation in left-dominant UPA
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Original publication
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